Heart attack

Pre-hospital care in the ambulance

“A suspected heart attack is treated as an emergency because of the possible damage to your heart, and the risk of death. Early treatment can save your life and can limit the amount of damage to your heart muscle.” [British Heart Foundation]
 
The people we talked to accessed pre-hospital care in various ways; by calling 999, by phoning NHS Direct or via their GP. They remembered being asked various questions, mostly about symptoms, such as “are you having chest pain," or "did you pass out?" – this type of information was passed to the responding ambulance crew.
 
James had a stroke a year before and was retired at the time of his heart attack. He said that he didn’t have what he described as the ‘classical’ heart attack symptoms and therefore waited a whole weekend before seeking medical attention.
 
Once the ambulance crew arrive, the diagnosing process continues. Paramedics usually do an electrocardiogram (ECG) to check the heart's rhythm and find out if the symptoms are due to a heart attack. Depending on what the rhythm looks like, and the symptoms described by the patient, paramedics may make a preliminary diagnosis of a heart attack. While the final diagnosis rests in the hands of doctors, that preliminary diagnosis is important because it allows paramedics to begin treatment immediately (often while still in the patient's home).
 
If people have a low level of oxygen in their blood, ambulance staff may give them oxygen. To relieve pain they may administer morphine intravenously (through a vein), glyceryl trinitrate (GTN) - as a tablet under the tongue or as a spray and an aspirin to chew to thin the blood.
 
Ambulance crews also provide emotional support by reassuring and comforting those who feel distressed or worried about their situation.
 
People we talked to found it reassuring being in the ambulance and receiving treatment even before they arrived in hospital. Some had an ECG done in the ambulance which was then transmitted electronically to the Coronary Care unit in the hospital, enabling healthcare staff to plan treatment before the person arrived at the hospital (see 'Making a diagnosis'). 
 
Primary angioplasty is performed in some, but not all, hospitals. This is another reason to do an ECG in the ambulance' to establish if the person is having a heart attack in order to take him/her to the most appropriate hospital.
 
During a heart attack there is also the risk of having a cardiac arrest. This is when the heart stops pumping blood and normal breathing stops. The paramedics or ambulance staff have a defibrillator with them. One or more electrical shocks from the defibrillator can restore a normal heart rhythm and save the person’s life.
 
Everyone we talked to praised the ambulance crew for their help, their prompt arrival and the care provided. Looking back, John said that the whole experience would have been less anxious for his wife if she had travelled in the ambulance with him, instead of by car with their daughter.
 
Under the Department of health - Treatment of Heart Attack National Guidance, the importance of timing and how quickly treatment is given is vital. The experiences of the people we talked to showed that on average they waited for about 10 to 20 minutes for ambulance crews to arrive and a bit more if they lived in rural areas. People who have had a heart attack need to be treated within two hours to make primary angioplasty effective and to avoid further damage to the heart muscle.

Added March 2013.

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